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A544
October 16, 2011
8:00:00 AM - 11:00:00 AM
Room Hall B2 Area E
A Simple Technique to Improve Oxygenation and Reduce the Risk of Fire Hazard in Propofol-Sedated Patients during Short Surgical Procedures
Michael J. Wong, M.D., Christine W. Hunter, M.D., Shaul Cohen, M.D., Branson Collins, M.D., James Tse, M.D.,Ph.D.
UMDNJ-Robert Wood Johnson, New Brunswick, New Jersey, United States
Introduction: Desaturation (Desat) is common in deeply sedated patients receiving nasal cannula (NC) O2 even during short surgical procedures. Raising NC O2 flow to improve oxygenation increases O2 under surgical drapes

and the risk of fire hazard.1 A plastic sheet has been shown to improve oxygenation in patients by transforming NC to a face tent without raising O2 flow during EGD.2 We examined its effectiveness in improving oxygenation and assessed O2 level under surgical drapes during short procedures.

Methods:
This retrospective review of patients who underwent various surgical procedures (breast biopsy, AV fistula, cystoscopy, D & C, hysteroscopy, hernia repair) identified 2 groups. Group 1 received NC O2 (34 NC). Group 2 received NC O2 and a TSE "Mask" (106 TM) using a plastic specimen bag2-3 or a fluid-shield surgical mask (Photo).4 Patients received NC O2 (3-5 l/min) and only IV propofol. Data collected included O2 saturation (Sat), FiO2 and O2 under surgical drapes. Student's t-test and Chi Square test were used for analysis. A p value < 0.05 was considered as significant. (Mean±S.D.)

Results:
Among patients who underwent short procedures (≤30 min), there were no differences in age (NC:49±21 yrs; TM:50±19), BMI (NC:26.0±4.1; TM:28.2±6.4), ASA Physical Status (ASA) (NC:2.1±0.7; TM:2.1±0.8), room air (RA) O2 Sat (NC:99±1%; TM:98±2%), duration (NC:22±6 min; TM:21±7) and overall propofol dosage (NC:165±93 ug/kg/min; TM:203±96). There were significant differences in O2 flow (NC:5.4±2.1 l/min; TM:4.5±1.0), lowest O2 Sat (NC:93±10%; TM:98±3%) (Fig 1) and severe Desat (O2 Sat≤85%) (NC:5/17; TM:1/37) (Fig 2), bag-mask ventilation (NC:2/17; TM:0/37), FiO2 (NC:32±8%; TM:61±22%) and O2 under surgical drapes (NC:42±14%; TM:21±0%).

Among patients who underwent lengthy procedures (>30 min), there were no differences in age (NC:54±12 yrs; TM:54±15), ASA (NC:2.2±0.9; TM:2.1±0.7), BMI (NC:27.1±6.7; TM:28.7±6.6), RA O2 Sat (98±2%), duration (NC:66±27 min; TM:58±26), propofol dosage (NC:134±48 ug/kg/min; TM:152±68) and bag-mask ventilation (NC:0/17; TM:0/69). There were significant differences in O2 flow (NC:6.2±1.6 l/min; TM:4.5±1.0), lowest O2 Sat (NC:90±9%; TM:97±3%), severe Desat (O2 Sat≤85%) (NC:3/17; TM:0/69), FiO2 (NC:32±10%; TM:59±16%) and O2 under surgical drapes (NC:41±13%; TM:22±1%).

Discussion:
Data show that No-Cost TSE "Mask" improves oxygenation and prevents severe desaturation in propofol-sedated patient during short and lengthy procedures. This simple face tent may improve patient safety by increasing O2 delivery without raising O2 flow. It reduces risk of fire hazard by preventing O2 pooling under surgical drapes and should be routinely used even during short surgical procedures.

Ref:
1. J Anaesth Clin Pharm 22:199, 2006; 2. Anesth 107:A922, 2007; 3. Anesth 102:484, 2005; 4. www.TSEMask.com
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